Abstract

Background

Acute respiratory failure (ARF) and severe sepsis (SS) are possible complications
in patients with community-acquired pneumonia (CAP). The aim of the study was to evaluate
prevalence, characteristics, risk factors and impact on mortality of hospitalized
patients with CAP according to the presence of ARF and SS on admission.

Methods

This was a multicenter, observational, prospective study of consecutive CAP patients
admitted to three hospitals in Italy, Spain, and Scotland between 2008 and 2010. Three
groups of patients were identified: those with neither ARF nor SS (Group A), those
with only ARF (Group B) and those with both ARF and SS (Group C) on admission.

Results

Among the 2,145 patients enrolled, 45% belonged to Group A, 36% to Group B and 20%
to Group C. Patients in Group C were more severe than patients in Group B. Isolated
ARF was correlated with age (p < 0.001), COPD (p < 0.001) and multilobar infiltrates
(p < 0.001). The contemporary occurrence of ARF and SS was associated with age (p = 0.002),
residency in nursing home (p = 0.007), COPD (p < 0.001), multilobar involvement (p < 0.001)
and renal disease (p < 0.001). 4.2% of patients in Group A died, 9.3% in Group B and
26% in Group C, p < 0.001. After adjustment, the presence of only ARF had an OR for
in-hospital mortality of 1.85 (p = 0.011) and the presence of both ARF and SS had
an OR of 6.32 (p < 0.001).

Conclusions

The identification of ARF and SS on hospital admission can help physicians in classifying
CAP patients into three different clinical phenotypes.